Provider Demographics
NPI:1427522028
Name:COLEMAN, CRYSTAL DAWN (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1270
Mailing Address - Country:US
Mailing Address - Phone:606-263-4283
Mailing Address - Fax:
Practice Address - Street 1:390 PARK AVE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:910-742-9243
Practice Address - Fax:888-746-1787
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2023-04-25
Deactivation Date:2023-03-15
Deactivation Code:
Reactivation Date:2023-03-15
Provider Licenses
StateLicense IDTaxonomies
KY3013044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily